OP0182-HPR EFFICACY OF NON-PHARMACOLOGICAL INTERVENTIONS: A SYSTEMATIC REVIEW INFORMING THE 2023 EULAR RECOMMENDATIONS FOR THE MANAGEMENT OF FATIGUE IN PEOPLE WITH INFLAMMATORY RHEUMATIC AND MUSCULOSKELETAL DISEASES
Authors: E. Santos, B. Farisogullari, E. Dures, P. Machado
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Several EULAR recommendations for the management of people with specific inflammatory rheumatic and musculoskeletal diseases (I-RMDs) have highlighted the importance of some non-pharmacological interventions in the management of fatigue [1-3]. However, these recommendations are either disease-specific or focusing on a single intervention, and lack an integrated view of the overall evidence for fatigue management with non-pharmacological therapies in the wider context of all I-RMD. <h3>Objectives</h3> To identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with I-RMDs and to summarise their safety in the identified studies to inform EULAR recommendations for the management of fatigue in people with I-RMD. <h3>Methods</h3> Systematic review of adults with I-RMD conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction, and synthesis performed by two reviewers independently. Data pooled in statistical meta-analyses. <h3>Results</h3> From a total of 4,150 records, 454 were selected for full-text review, 82 fulfilled the inclusion criteria, and 55 RCTs were included in meta-analyses. Physical activity or exercise were efficacious in reducing fatigue in rheumatoid arthritis (RA) (SMD=-0.23, p&lt;0.001), systemic lupus erythematosus (SLE) (SMD=-0.54, p=0.04) and spondyloarthritis (SpA) (SMD=-0.94, p&lt;0.001). A reduction in fatigue was also observed in Sjögren's syndrome and systemic sclerosis, although not statistically significant (SMD=-0.83, p=0.21; SMD=-0.66, p=0.06, respectively). Psychoeducational interventions were efficacious in reducing fatigue in RA (SMD=-0.32, p&lt;0.001), but not in SLE (SMD=-0.19, p=0.18). Follow-up models in consultations and multicomponent interventions reduced fatigue in RA, although the effect was not statistically significant (SMD=-0.05, p=0.71; SMD=-0.20, p=0.24, respectively) (<b>Figure 1</b>). The narrative results of the RCTs not included in the meta-analysis indicated that several other non-pharmacological interventions were efficacious in reducing fatigue, with reassuring safety results. <h3>Conclusion</h3> Non-pharmacological interventions are efficacious and safe for the management of fatigue in people with I-RMD. <h3>References</h3> [1] Smolen JS, et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. <i>Annals of the rheumatic diseases</i>. 2015;75:3. [2] Rausch Osthoff A-K, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. <i>Annals of the Rheumatic Diseases</i>. 2018;77:1251. [3] Nikiphorou E, et al. 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. <i>Annals of the rheumatic diseases</i>. 2021;80:1278. <h3>Acknowledgements</h3> E Santos and B Farisogullari contributed equally to the manuscript. <h3>Disclosure of Interests</h3> Eduardo Santos: None declared, Bayram Farisogullari: None declared, Emma Dures: None declared, Pedro Machado Speakers bureau: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UCB, Consultant of: Abbvie, BMS, Celgene, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Orphazyme, Pfizer, Roche and UC.B.